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Monday Morning Update 4/16/12

April 15, 2012 News 20 Comments

From ZZtop: “Re: Meditech ambulatory. Meditech is developing an ambulatory product written in part with M-AT (focus) and M-AT WebServer (unreleased and a SAAS application). It will be available in 2013 starting at the 6.1X product line as they are merging P/BR and B/AR into one application. The design is very un-Meditech with horizontal tabs. Looks a bit Epic-ish.” Unverified.

From Epic Dude: “Re: Nuance. Apparently sunsetting their RadPort imaging decision support service.” Unverified.

From Senor Ortega: “Re: [company name omitted]. Ceased operations on Monday, April 9 and will declare bankruptcy next week, according to an e-mail sent by a member of their board of directors.” Unverified, so I’ve left the company name out for now. I e-mailed and asked them to confirm or deny and will re-run with their name if they don’t respond.

4-15-2012 4-37-45 PM

From Dr. Beeper: “Re: Henry Ford Health System. They spent $150 million to replace the 25-year-old McKesson MIMS product starting in 2006, bringing in CSC, RelWare, and Siemens to develop Care Plus Next Generation (the intellectual property is still owned by HFHS and RelWare.) That product did not have revenue cycle capabilities and it captured, normalized, and stored data from over 150 interfaces. HFHS needed to replace 150 individual solutions with a single, unified record with full RCM, inpatient, and ambulatory. That’s why they are spending $300 million on Epic.” Above is a March 2011 quote from the HFHS’s president and COO, talking to the local TV station upon Care Plus Next Generation’s go-live. Eight months later, HFHS was finalizing its contract with Epic to replace the whole thing.

From Epic Envy: “Re: Epic. I get it, Epic is the best of a bad lot. They’ve copied the Meditech business model and have executed it well. But does anyone really believe their KLAS scores aren’t ‘engineered?’ Ask who is KLAS’s biggest paying customer while reading KLAS’ users comments. Ask yourself what effect their ‘good maintenance’ contract incentive has on muting malcontents. Finally, allow your mind to wonder why they don’t foster the use of social media customer dialogue. I am envious, indeed but not naive.” Point A, not effective – just because they’re a KLAS customer doesn’t automatically mean they get to fudge the numbers and I don’t think they control the results any more than other vendors who encourage certain customers to participate. Point B, effective, but I think there’s another factor that automatically quiets down any complainers – who wants go to public with gripes after you’ve just spend hundreds of millions of dollars on Epic? (the hospital’s board would not appreciate public second guessing after approving a decision of that magnitude and the messenger would undoubtedly be shot). Point C, not effective – customers can talk among themselves all they want and I haven’t heard any say that Epic’s giant user group meeting is full of bitter complaining like I’ve seen at similar events held by Epic’s competitors. Point B wins – nobody buys a Rolls Royce and then whines about crappy gas mileage or expensive oil changes because it would just make them look stupid for buying it in the first place. Compounded by the fact that Epic seems to be pretty open with its customers, so there’s not a lot to be gained by airing dirty laundry to a bunch of sideline-watchers, especially when the company is privately held and thus not too worried about negative publicity that might otherwise get shareholder attention.

From Deep Throat: “Re: Thomson Reuters Healthcare Division. Any news about who has purchased it?” I haven’t heard anything, but maybe someone has and will share.

From The PACS Designer: “Re: Windows 8.  Microsoft has released a consumer preview for Windows 8. The new version has vast changes from previous versions and will take some time to get used to if you are in the market for a new system.  In many respects, it appears that Microsoft is trying to challenge Apple’s iPhone/iPad user interface to create some marketing buzz amongst consumers.” Microsoft couldn’t possibly do like everyone else and post the intro video on YouTube or something that might involve a competitor – they had to run it in the non-shareable, proprietary Silverlight format. Luckily someone smarter than the Microsoft marketing folks (why wouldn’t you use a competitor’s free service to pitch your product?) posted an intro video to YouTube where someone might actually see it, which I’m including above. We’ll see on Win 8. Given the radical changes, I’m not convinced it won’t follow the “every other release sucks” pattern like Vista before it and Windows ME before that.

4-15-2012 3-40-53 PM

HIStalk readers apparently aren’t all that interested in the JOBS act and aren’t that optimistic that it will spur startup growth and create jobs. New poll to your right, from recent headlines: should hospitals decline to hire overweight people or smokers? The poll accepts comments, so feel free to argue your position.

My Time Capsule editorial this time around: Rogue IT Shops: Provide Rules, but Leave Them There. A flash of the goods: “As soon as IT gets in trouble or tries to hide staff shortages like a balding man’s comb-over, it’s all hands on deck to save the tanking projects, meaning those previously dedicated departmental resources will be yanked to put out some new fire, often self inflicted by poor planning.”

I periodically need to vent about a pet peeve, so here’s one: a character-based GUI is not the same as a DOS application. If you hear someone refer to Meditech Magic or a mainframe app as “DOS-based,” stop listening because they just revealed a startling lack of even basic IT knowledge. I’m also lately irked when I read, “I had a couple drinks …” or something like that where somehow the author feels the “of” separator is superfluous, which to me sounds like someone who’s talking after more than just two drinks.

4-15-2012 2-10-50 PM

FirstHealth of the Carolinas CIO Dave Dillehunt left an excellent comment he left on Travis’s HIStalk Mobile post on pagers that hits a point I’ve been trying to tell people about: one-way pager coverage sucks and is getting worse once you get even a few miles away from a reasonably sized city, just like cell phones of the 1990s. They work fine on a hospital campus, but not well for folks covering call from home or traveling even locally. Not to mention that if you aren’t in range when the page goes through – unlike a cell phone – there’s no notice to the sender or voice mail for the recipient since alpha paging is incredibly unintelligent technology. For example, above is a USA Mobility coverage map for Tennessee. They may well have statewide coverage, but only if you’re in the blue areas (which look to be maybe 10% of the geographic area), so if you’re on weekend call, the electronic leash is pretty short. There may be a way for the commonly used Amcom paging system to detect failed delivery or to allow users to forward to a cell number to have the page converted to an SMS text message, but I haven’t figured it out if so. Anyway, here’s what Dave had to say:

Because traditional paging technology is dying, and customers are leaving in favor of their smart phone texting apps, the industry is now milking what revenues they have left and are no longer repairing or replacing damaged and failing paging towers and equipment. As a result, paging coverage is rapidly deteriorating. This is now causing more people to abandon that technology, further worsening the problem. While cellular coverage is sketchy as well, technologies that send out through both cellular and wi-fi are a good start and probably provide better coverage than the current (worsening) paging coverage. Our physicians (and others) are now demanding something other than paging (beeper) systems. Personally, I predict that paging will be gone within 36 months.

Cell phones probably can’t replace pagers for a variety of reasons, though: (a) cell plans cost too much to give every pager-equipped employee a cell phone instead; (b) wireless carriers price text messaging ridiculously high given the few hundred bytes of bandwidth a text message consumes; (c) cell coverage is often bad in specific areas of a hospital; and (d) it’s harder to set up a virtual cell phone that would allow one-number coverage by multiple people without requiring them to pass a physical phone among themselves. In other words, pagers are still used despite ample faults because they are cheap and generally work will given known limitations.  I was trying to decide if a “one number” service like Google Voice could be used to overcome these issues, allowing someone to auto-forward to an SMS message, pager, or e-mail of their choice. You might want to give that some thought given Dave’s prediction of the demise of alpha paging in the near future, which seems entirely reasonable to me.
 
New from Practice Fusion: a chat-like function that allows physicians to securely communicate with each other. Future enhancements will cover chart notes, attachments, and referrals. Another recent enhancement includes a site where consumers can review their physicians. Other upcoming features mentioned in this article: appointment scheduling, the ability for patients with similar conditions to be able to communicate with each other and seek second opinions, and real-time online patient visit capability.

Mercy Memorial Hospital System (MI) goes live with Indigo Identityware user authentication and single sign-on.

4-15-2012 1-34-16 PM

Chris Rangel MD, an internist at El Paso Hospitalist Group (TX), posts on his blog an editorial that likens today’s EMRs to electronic bulletin board services of the 1980s rather than the Facebook of today. He’s mostly griping because EMRs don’t talk to each other, which bulletin boards didn’t either. The point he didn’t make: the financial model didn’t encourage either BBSs or EMRs to interoperate (not to mention that the big story with the Internet isn’t that it killed BBSs, but that it killed the distribution model of expensive, shrink-wrapped applications sold by physical stores.) The Internet came along, which was sold as a free service with local connectivity charges that allowed users to run whatever they wanted without worrying about the connectivity aspect. Even Internet-based EMRs aren’t really designed for open data sharing, for a variety of reasons that have no parallels in BBSs: HIPAA, patient consent, the belief of the physician customer that it’s their data and not that of the patient, and lack of demand (both patient and physician) for consistent exchange of patient information. All reasons aside; his Facebook model would fan to life if customers demanded it with their dollars, but they aren’t (and if a Facebook-like app would really provide any value as an EMR for doctors expecting to be paid and to retain legal records, which it would not.) They are just occasionally complaining while continuing to reward the status quo by paying their current vendor, helped along by ONC taxpayer-funded bribes to stick with what was already being sold.

4-15-2012 2-31-19 PM

Medicomp Systems promotes Dave Lareau to CEO. He had been COO since 1995. Founder Peter Goltra will remain as chairman and president.

4-15-2012 3-23-37 PM

Beaumont Health System (MI) promotes Subra Sripada to EVP/chief administrative & information officer. He was previously SVP/CIO.

A letter to the editor of an Ohio newspaper complains that the author’s primary care provider, who is implementing an EMR, asks patients too many personal questions in his four-page intake form, such as marital status, who the patient lives with, diet, and whether firearms are kept in the house. He concludes, “You are probably thinking, so what do all of the above-mentioned things have to do with medical records? That’s my question, too. Could it be that Obamacare has reached our city already? Do you want all this information out in cyberspace? I think not!” 

Vince covers Commodore founder Jack Tramiel this week.

This week’s employee e-mail from Kaiser Permanente Chairman and CEO, like many of those he writes, focuses on its HealthConnect system:

In Europe, we won’t win any awards but the HIMSS conference in Copenhagen will basically have a Kaiser Permanente morning featuring a keynote speech about KP followed by several sessions involving Ministers of Health from European countries who will — in part — be discussing what KP is now doing. That is next month. In two months, more than 30 chief information officers from around the world will come to a special meeting in Oakland to spend a couple of days learning from our IT leaders and our health care leadership, our agenda, and our successes. 

The Riverside, CA paper profiles iMedRIS, which offers Web-based research management tools (such as IRB.) The company has 30 employees and plans to hire 20 more by the end of the year.

At TEDx San Jose, GE Healthcare Innovation Architect Doug Dietz moves the audience to tears in describing his efforts to make MRI machines less frightening to children. He describes his work in the video above, which is not from the actual presentation.

A British newspaper seems way too incensed about what sounds like a minor data faux pas: a “fiasco” occurred with NHS patient data was “dumped” by GE Healthcare on servers physically located in the US, which the newspaper says (with nothing to back it up) made politicians and civil libertarians “furious” even though absolutely nothing happened with the data as a result. The only interesting part of the article was the name of the privacy advocate quoted: Nick Pickles.

E-mail Mr. H.


The Healthcare IT Week in Review

1. Utah: Do These Breaches Make My Butt Look Big?

Facts and Background

European hackers penetrate a Utah Medicaid claims server, downloading files covering nearly a million individuals and stealing the Social Security numbers of more than 250,000 of them.

Opinion

Hackers can get into anything stored online given the proper motivation and resources. Breaches happen all the time. This just happened to be a very large one and the state  government just happened to be very wrong in its initial assessment of the extent of the breach.

Musings

  • Of all the things you could profitably hack, why would you want to steal the identities of welfare recipients? Possible answer: health records are often complete and therefore a convenient package for stealing someone’s identify.
  • An IT technician’s weak password was identified as being cracked to gain access. That illustrates two points: (a) trying to compose and remember a bunch of complex passwords means most people won’t do it, and (b) at least this was a refreshing way to hack since most PHI exposures are due to inappropriate server security settings rather than old-school password cracks.
  • The more other industries beef up their information security because they can and must, the more healthcare becomes the target of choice because security is primitive compared to that used by banks and retailers. Not to mention that healthcare records may include valuable data elements these days, such as bank account and credit card information.
  • Utah had better be glad it’s not two states west since California’s breach penalty would have triggered an automatic penalty of $800 million.
  • The state is now warning consumers that scammers may take advantage of the situation by calling people up randomly, telling them their information may have been compromised, and asking them to provide personal information (like their SSN) to find out.
  • Adequate security is probably an unreasonable target when possession of just a couple of numbers (SSN, insurance ID, date of birth, etc.) is presumed to be positive identification to receive expensive benefits.

2. DoD’s EMR, Out-Of-Control Psychiatrists Prescribing Blamed for Addicted Marines 

Facts and Background

Poor EMR medication functionality is partly to blame for high rates of abuse of both prescribed and illicit drugs in a program for wounded Marines, according to the Defense Department’s inspector general. Also blamed is overprescribing of addictive drugs, particularly by psychiatrists.

Opinion

It may well be that the multi-billion dollar AHTLA EMR can’t bring in data from community pharmacies or the VA to help prescribers identify overmedicated patients. However, that would put it right on par with the systems used by non-military doctors.

Musings

  • For identifying patients who may have an addiction problem, why can’t the government ignore prescribing records and instead look at pharmacy dispensing records? The only ways the problem can be identified in the private sector are by doctor shopper databases and examination of claims records (which won’t work if drug-seeking patients get smart and pay cash).
  • While illegally obtained drugs are mentioned in the report, the emphasis seems to be on those prescribed from a sound doctor-patient relationship. In other words, the real problem is the doctors doing the prescribing, who in the absence of other motivation must think they’re doing the right thing clinically (i.e, it’s an education problem).
  • The problem here is the same as it is in private medicine: doctors are pressured by patients to overprescribe, use of addictive drugs is often anything but evidence based, and any crackdown means chronic pain patients with a legitimate need for aggressive pain therapy will suffer from under-medication.

3. 3M Acquires CodeRyte

Facts and Background

3M announced last week that it acquired CodeRyte, which offers medical coding tools based on extracting information from free text using natural language processing. 3M was already using CodeRyte’s technology in some of its offerings.

Opinion

CodeRyte had put together some attention-grabbing bullet points: 250 customers, heavy penetration into deep pockets academic medical centers, 3M’s reliance on its products, and a potential ICD-10 play. If you’re going to make yourself attractive to a potential acquisition partner, it’s nice when your attributes make a deep pockets partner the logical choice.

Musings

  • CodeRyte’s #1 philosophy, according to its corporate overview, was to “stay private as long as possible to allow the technology to become ubiquitous rather than a benefit to a small subset of health care through one vendor’s client base.” I translate that to mean, “3M, you’d better bring a wheelbarrow full of money if you want to get our attention.” Which I assume was the case.
  • The company had brought over some former Cerner execs: Glenn Tobin as COO and Don Trigg as chief revenue officer.
  • CodeRyte’s board of directors had five members other than CEO Andy Kapit. Every one of them was from a different venture capital firm with investment in the company. Surely the company’s financial ambitions were obvious.
  • 3M has a steady cash cow in coding solutions and it has made few obvious acquisitions or investments in that market. This move seems preordained.
  • The integration of CodeRyte’s product into 3M’s was not all that great, at least according to folks I talked to. Now 3M loses both its barrier and its excuse.
  • 3M and Nuance announced just over a year ago a deal to deliver computer-assisted physician documentation and coding solutions from speech recognition. I don’t know if 3M’s contribution of the coding technology relied on CodeRyte to take the Nuance-converted dictation text and apply NLP to it, but that seems reasonable.
  • CodeRyte’s technology was developed by linguistics professor Philip Resnick PhD, who still advises the company.
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Currently there are "20 comments" on this Article:

  1. Dear Epic Envy, Your comments on the KLAS methodology do not even begin to get at the horrors it represents. KLAS is the exact opposite of real survey methods. Anyone who pays any attention to KLAS gets what they deserve: total nonsense.

    Note: this is not an idle opinion: This is from a research methods professor.

  2. Thomson Reuters tried to sell its healthcare division but no suitor was willing to put up the hefty dowry to walk away with this bride. TR is hanging on to the division for now but unlikely to invest in it and will simply await a more opportune time to unload this asset. Not exactly the best strategy for company morale.

  3. I think what people fail to remember and what KLAS fails to adequately promote is that it is a perception study. If product X does exactly what it is supposed to do, that’s great, but it should not be lumped in a report with product Y, which also does exactly what it’s supposed to, but is far more complex and requires more design input/support. Greater satisfaction with an inferior product does not mean the product is better or better suited to the end goal. The satisfaction surveys KLAS presents are flawed.

    [From Mr H] This is one of the most original and insightful comments I’ve seen related to KLAS — questioning the premise that Product A’s ratings from its users can be compared to Product B’s ratings from its users. In any other consumer study, you would have the same people try both products and rate them using their same perceptions, assumptions, and biases. In that regard, a vendor can be helped or hurt more in KLAS “rankings” of who has chosen its product than by the quality of its product. And as we all know about Epic, it declines to sell to prospects it deems likely to fail, which now makes two reasons that it’s a good strategy.

  4. Re Epic Envy
    I wonder about KLAS now that we have Epic. How can reality for me be so different that the ratings? It is indeed best of a bad lot. That is all. A Daewoo with a great PR, sales, and repair department.
    By the way, the BAD ratings seen in KLAS on the couple products we have/had that I know are crap are entirely accurate!

  5. Actually, several PE firms appear to be in diligence for T-R (a dogs breakfast of M&A if ever I saw one) – if one emerges, I expect they’ll start selling off some pieces to rationalize it (and get a quick return of some invested capital).

  6. KLAS haterz: find someone with a KLAS account and read the customer comments for each of the vendors. I know they are taken verbatim from “real” customers because I can almost always tell which of our clients is being quoted. You’re a fool if you can’t see the patterns within those comments. And I agree with Dr. T: KLAS vendors with bad comments are the bad vendors.

    The constant whining about the KLAS score manipulation is weak, too. You don’t have to be a current customer, as I recall, to provide a report to KLAS. If you had EPIC at your recent hospital and hated it, you can be interviewed just as much as someone still using it. KLAS won’t let you hand out surveys at user conferences and requires a KLAS employee to witness and survey gathering you do…and even then the scores don’t go into the bin.

    I DO suspect that, in the case of EPIC, they aren’t getting as many front-line users as, say, the ambulatory products. The people who often make the purchasing decision for Greenway, eCW, SRS, etc., are often the people who wrote the check AND use the software. When it comes to EPIC, the people who made the purchase decision did it with someone else’s money and don’t have to use it to actually, you know, chart a patient. At least, at the end of the spectrum I deal with, that’s what I see.

  7. Whoops, I forgot:

    Dr. T – log into KLAS. Volunteer your opinion. I guarantee that EPIC will read your comments and notice if someone gave them sub-optimal scores. Perhaps a lot more than any complaint made to the support crew.

  8. RE Epic Envy
    KLAS also does not take into account the value adjusted differential between Product A and Product B.

    If I buy a Rolls Royce and pay $250,000 and it works well I will give it a 9 due to the high quality car and the bells and whistles. If I buy a Toyota Carolla and it runs well but has no bells and whistles and costs $20,000 I may rate it as a 5 for being a good stable car. I would also be much more likely to complain about the Carolla as I would look dumb complaining about my new Roll Royce.

    If I were a board member of a company though and the difference between the Carolla and Rolls Royce was that stark given a similar level of capabilities that value adjustment would be an important factor.

  9. Need some help from the awesome visitors of this site. For an academic project, I need to talk to a few ambulatory, primary care practices of 25-50 physicians in the Chicagoland area who have an EMR. I have not been able to get this information online – so any help will be much appreciated.

    mustaqeem@chicagobooth.edu

  10. David – although there is surely some Mercedes effect in the KLAS data, the “big/expensive” vendors aren’t all on top. This is especially true in the ambulatory sections. Evan Steele @ SRS wrote a blog piece showing a negative correlation between being publicly held and KLAS scores.

    KLAS scores, to me, reflect the opinions of the people on one side of the fence. Everyone questions the validity of KLAS when EPIC gets such good scores…yet, they are crushing the competition right now. KLAS measures the opinions and feelings of customers, so why should we expect EPIC to have anything BUT good scores? Poor scores from EPIC would reflect a certain kind of bias, no, that KLAS is actively searching people to refute EPIC’s success?

    IMO, KLAS scores are most interesting when they really differ from the sales patterns of the vendors. Sometimes, the KLAS results act as an interesting predictor.

  11. RE: Geezer

    It sounds like you are stating that we should accept that perception is reality at face value as opposed to understanding the potential bias behind the perception.

    Out of curiosity, do you see KLAS scores being a leading or a lagging indicator of initial sales choices? Or one that is managed as part of an indirect marketing campaign?

  12. RE: Charles Baggage says:

    On two occasions Mr. Baggage, you have been asked, ‘Pray, Mr. Babbage, if you put into the KLAS machine wrong figures, will the right answers come out?’ At which time Mr. Baggage retorted, ” I am not able rightly to apprehend the kind of confusion of ideas that could provoke such a question.”

    Maybe I am addressing the wrong Mr. Baggage? 🙂

  13. I’ve been in this healthcare field on the vendor side for more than 30 years, and always thought that the KLAS surveys were fair and impartial. They are a good measure of vendor performance which helps vendors improve their products to satisfy actual usage by clients. Even with this assessment, there is always some tainted comments influenced by vendor preferences of the survey responders. As far as Epic is concerned, they have very few good challengers, and will most likely have much higher scores than other vendors.

  14. The problem with KLAS scores, is they don’t reflect the opinions of the users that are “stuck” implementing a “model system”, that is not based in real-life healthcare workflows, rather, KLAS reflects the opinions of the individual who talked her or his board into spending $100’s of millions on a system that most likely went past targeted milestones and was way over budget……and once one has already spent $100 million, how can she or he objectively rate that vendor without discrediting her or his own job performance in selecting the vendor?

  15. Not to nitpick, but BBSs COULD and DID talk to each other. Fidonet was a psuedo-wide area network one could set up on their bulletin board system. Sort of like the “interoperability” of today’s EMRs.
    er…I hope I didn’t just show my age.

  16. Re: Windows 8. For the heck of it, I started watching the video. The guy lost me at “picture password”. To quote: “I just draw lines, dots, and circles on the picture to sign into the PC”. Huh? How’s that a password?

  17. Wow – say “Epic” and “KLAS” and you really get a party started!

    How about some positivety – congrats to Dave Lareau from Medicomp! An old (sorry Dave) Med Man hand does well for himself at a good company.

    Congratulations – it is well deserved!

  18. Re: The Healthcare IT Week in Review; #3 – 3M Acquires CodeRyte; 3M and Nuance announced just over a year ago…. I don’t know if 3M’s contribution of the coding technology relied on CodeRyte ….

    It’s my understanding that 3M’s contribution of the coding technology did not rely on CodeRyte for the 3M/Nuance arrangement. 3M was using CodeRyte’s “statistical”-based NLP for its outpatient CAC solution. 3M’s inpatient CAC solution and the 3M/Nuance arrangement relied on Nuance’s “rules”-based NLP (Which one? Nuance’s Dragon NLP? Nuance’s former e-Scription NLP? Always hard to tell.) Which is, perhaps, one reason why the integration of CodeRyte’s product into 3M’s “was not all that great”. According to a 3M post, “The acquisition of CodeRyte enables 3M to deepen the integration between Nuance, CodeRyte, and 3M’s NLP technologies to continue improving a single, comprehensive healthcare NLP system….”

  19. Perception is reality. Just like the only Delta “how did we do survey on you trip to…” survey. I only answer it when I’m pissed.







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